Asunto(s)
Delirio , Melatonina , Humanos , Melatonina/uso terapéutico , Delirio/prevención & control , HospitalesAsunto(s)
Analgesia Epidural , Humanos , Embarazo , Femenino , Analgesia Epidural/métodos , Analgesia Obstétrica/métodosRESUMEN
NO. In general, nonoral estrogen use for menopausal symptoms is associated with a lower cardiovascular (CV) risk profile than oral estrogen use (strength of recommendation [SOR], B; meta-analysis of cohort studies). Vaginal estrogen use is associated with lower risk for coronary heart disease (CHD) and similar risk for myocardial infarction (MI), stroke, and deep vein thrombosis/pulmonary embolism (DVT/ PE) compared with nonuse (SOR, B; cohort studies). Vaginal estrogen therapy also is associated with lower CV-related mortality for 3 to 5 years compared withnonuse (SOR, B; cohort study). No high-quality randomized trials address this topic.
Asunto(s)
Enfermedad Coronaria , Infarto del Miocardio , Embolia Pulmonar , Femenino , Humanos , Estudios de Cohortes , Estrógenos/efectos adversos , Infarto del Miocardio/inducido químicamente , Infarto del Miocardio/epidemiología , Factores de RiesgoAsunto(s)
Oxitócicos , Hemorragia Posparto , Embarazo , Femenino , Humanos , Hemorragia Posparto/prevención & control , OxitocinaRESUMEN
It depends. A diagnosis of chronic obstructive pulmonary disease (COPD) made using screening spirometry in patients without symptoms does not change the course of the disease or alter smoking rates (strength of recommendation [SOR]: A, preponderance of evidence from multiple randomized controlled trials [RCTs]). However, once a patient develops symptoms of lung disease, a delayed diagnosis is associated with poorer outcomes (SOR: B, cohort studies). Active case finding (including the use of spirometry) is recommended for patients with risk factors for COPD who present with consistent symptoms (SOR: C, expert opinion).
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Humanos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Espirometría , Fumar/efectos adversos , Diagnóstico PrecozRESUMEN
Fairly accurate. Photometric transcutaneous bilirubin (TcB) testing may overestimate total serum bilirubin (TSB) in neonates with darker skin tones by a mean of 0.68 to > 2 mg/dL (strength of recommendation [SOR]: C, diagnostic cohort studies with differing reference standards).Overall, TcB meters retain accept able accuracy in infants of all skin tones across a range of bilirubin levels, despite being more likely to underestimate lighter skin tones and overestimate darker ones (SOR: C, diagnostic cohort studies with differing reference standards). It is unclear if the higher readings prompt an increase in blood draws or otherwise alter care.
Asunto(s)
Ictericia Neonatal , Humanos , Recién Nacido , Ictericia Neonatal/diagnóstico , Pigmentación de la Piel , Bilirrubina , Tamizaje Neonatal , Estudios de Cohortes , PielRESUMEN
Evidence-Based Answer: Yes. Compared to the use of a transcervical balloon alone, combined cervical ripening with a balloon catheter and oxytocin shortens the time to overall delivery by 3 hours and the time to vaginal delivery by 4 hours, without altering the rate of cesarean section (strength of recommendation [SOR]: A, network meta-analysis). The effect is more pronounced in nulliparous patients (SOR: A, meta-analysis).When combined therapy is used, 6 hours of balloon time may result in faster delivery than 12 hours (SOR: B, single randomized controlled trial [RCT]). Fixed-dose oxytocin and titrated oxytocin appear to have similar effect when combined with a cervical ripening balloon (SOR: C, underpowered RCT).
Asunto(s)
Maduración Cervical , Oxitócicos , Cesárea , Femenino , Humanos , Trabajo de Parto Inducido , Oxitócicos/farmacología , Oxitócicos/uso terapéutico , Oxitocina/farmacología , Oxitocina/uso terapéutico , EmbarazoRESUMEN
YES. Long-term sodium bicarbonate therapy slightly slows the loss of renal function in patients with chronic kidney disease (CKD) and may moderately reduce progression to end-stage renal disease (strength of recommendation [SOR]: B, meta-analyses of lower-quality randomized controlled trails [RCTs]). Therapy duration of 1 year or less may not be beneficial (SOR: C, secondary analyses in meta-analyses).
Asunto(s)
Fallo Renal Crónico , Insuficiencia Renal Crónica , Bicarbonatos , Progresión de la Enfermedad , Femenino , Humanos , Fallo Renal Crónico/tratamiento farmacológico , Fallo Renal Crónico/prevención & control , Masculino , Insuficiencia Renal Crónica/tratamiento farmacológico , Bicarbonato de Sodio/uso terapéuticoRESUMEN
Likely yes. Point-of-care ultrasound (POCUS) screening for abdominal aortic aneurysm (AAA) by nonradiologist physicians is 98% sensitive and 99% specific, compared with imaging performed by radiologists (strength of recommendation [SOR]: B, meta-analysis of diagnostic accuracy studies mostly involving emergency medicine physicians). European family physicians demonstrated 100% concordance with radiologist readings (SOR: C, very small subsequent diagnostic accuracy studies).
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico , Competencia Clínica/normas , Tamizaje Masivo/normas , Médicos de Familia/normas , Sistemas de Atención de Punto/normas , Radiólogos/normas , Ultrasonografía/normas , Adulto , Anciano , Anciano de 80 o más Años , Competencia Clínica/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Médicos de Familia/estadística & datos numéricos , Sistemas de Atención de Punto/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Radiólogos/estadística & datos numéricos , Factores de Riesgo , Ultrasonografía/estadística & datos numéricos , Estados UnidosRESUMEN
MAYBE, but it's too soon to tell. There is limited evidence that ketamine by itself is effective in the very short term. Single-dose intravenous (IV) ketamine is more likely than placebo (odds ratio = 11-13) to produce improvement (> 50%) in standardized depression scores in 1 to 3 days, lasting up to a week. Twice- or thriceweekly IV ketamine improves symptom scores by 20%-25% over 2 weeks (strength of recommendation [SOR]: B, meta-analysis of small, low-quality, randomized controlled trials [RCTs] and a single small RCT).Augmentation of sertraline with daily oral ketamine moderately improves symptom scores for 6 weeks in patients with moderate depression (SOR: B, small, lowquality RCTs).Augmentation of oral antidepressants (duloxetine, escitalopram, sertraline, venlafaxine) with intranasal esketamine spray improves response and remission rates at 4 weeks (16% for both outcomes) in patients with predominantly treatment-resistant major depression (SOR: A, meta-analysis of RCTs).Ketamine therapy is associated with confusion, emotional blunting, headache, dizziness, and blurred vision (SOR: A, metaanalyses).Nasal esketamine spray produces the adverse effects of dizziness, vertigo, and blurred vision severe enough to cause discontinuation in 4% of patients; it also can produce transient elevation of blood pressure (SOR: A, meta-analyses).
Asunto(s)
Antidepresivos/efectos adversos , Trastorno Depresivo Resistente al Tratamiento/tratamiento farmacológico , Ketamina/efectos adversos , Administración Intranasal , Administración Oral , Adulto , Antidepresivos/uso terapéutico , Depresión/tratamiento farmacológico , Trastorno Depresivo Resistente al Tratamiento/prevención & control , Esquema de Medicación , Humanos , Ketamina/uso terapéutico , Inducción de Remisión , Resultado del TratamientoRESUMEN
Yes, a link has been established but not a cause-effect relationship. Shorter reported sleep duration in childhood is associated with an increased risk of overweight or obesity years later (strength of recommendation [SOR]: B, meta-analyses of prospective cohort trials with high heterogeneity). In toddlers, accelerometer documentation of short sleep duration is associated with elevation of body mass index (BMI) at 1-year follow-up (SOR: B, prospective cohort). Adequate sleep is recommended to help prevent excessive weight gain in children (SOR: C, expert opinion).
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Obesidad Infantil , Trastornos del Sueño-Vigilia , Índice de Masa Corporal , Humanos , Sobrepeso/complicaciones , Obesidad Infantil/complicaciones , Obesidad Infantil/epidemiología , Estudios Prospectivos , Factores de Riesgo , Sueño , Privación de Sueño/complicaciones , Trastornos del Sueño-Vigilia/etiologíaAsunto(s)
Alimentos Infantiles/normas , Hipersensibilidad al Cacahuete/prevención & control , Factores de Tiempo , Arachis , Femenino , Humanos , Lactante , Alimentos Infantiles/efectos adversos , Hipersensibilidad al Cacahuete/dietoterapia , Medición de Riesgo/métodos , Medición de Riesgo/tendenciasAsunto(s)
Acetaminofén/uso terapéutico , Antipiréticos/uso terapéutico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Ibuprofeno/uso terapéutico , Guías de Práctica Clínica como Asunto , Profilaxis Pre-Exposición/normas , Vacunación/efectos adversos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Fecal microbial transplant (fmt) is reasonably safe and effective. In patients who have had multiple Clostridium difficile infections (CDIs), fecal microbial transplant (FMT) results in a 65% to 80% cure rate with one treatment and 90% to 95% cure rate with repeated treatments compared with a 25% to 27% cure rate for antibiotics (strength of recommendation [SOR]: B, small open-label randomized controlled trials [RCTs]). Fresh and frozen donor feces, administered by either nasogastric tube or colonoscope, produce equal results (SOR B, RCTs). FMT has an overall adverse event rate of 30%, primarily involving abdominal discomfort, but also, rarely, severe infections (0.7%) and death (0.1%) (SOR: B, systematic review not limited to RCTs).
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/prevención & control , Trasplante de Microbiota Fecal/métodos , Prevención Secundaria/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Resultado del TratamientoRESUMEN
It's unclear whether educational initiatives alone alter vaccine refusal. Although about a third of parents cite herd immunity as motivation for vaccination, its efficacy in addressing vaccine hesitancy isn't clear. Multifaceted interventions (encompassing improved access to vaccines, immunization mandates, and patient education) may produce a ≥25% increase in vaccine uptake in groups with vaccine hesitancy and low utilization. Correcting false information about influenza vaccination improves perceptions about the vaccine, but may decrease intention to vaccinate in parents who already have strong concerns about safety. Discussions about vaccines that are more paternalistic (presumptive rather than participatory) are associated with higher vaccination rates, but lower visit satisfaction. Providers should thoroughly address patient concerns about safety and encourage vaccine use.